Texting improves link between sick teens and doctors

NEW YORK (Reuters Health) - Adolescents with chronic
diseases who were allowed to text their doctors were better
equipped to manage their own healthcare and more likely to
request help at the first sign of problems, a new study found.

"Give them a voice, and they will talk," lead author Dr.
Jeannie Huang told Reuters Health. "And that's really what we
want them to do."

Huang, from the University of California, San Diego, said
her study shows that using the Internet and cellphones to
communicate with youths has the potential to get them earlier
care and improve outcomes.

"How do you reach people who don't come into the clinic?"
she said. "Mobile technology is a great way because it's meeting
teens in their own space."

"Kids want to fit in. Oftentimes they don't want to bother
people. They often come into the hospital very sick. If they
tell me early, we can keep them out of the hospital," she said.

Huang had frequently seen teens with chronic
gastrointestinal problems wait a dangerously long time to seek
care for symptoms. She and other doctors who treat adolescents
with chronic illnesses say those delays are especially common as
young adults move from being pediatric patients into adult
medical practices.

Interventions to prepare young people for that transition
have been designed for individual chronic diseases. But they
have not always succeeded, and they have been expensive and
labor intensive, the authors write in Pediatrics.

Huang and her colleagues designed a single education and
communication tool called MD2Me in an effort to help young
adults with all chronic diseases transition smoothly into adult
healthcare.

The researchers studied 81 adolescents between 12 and 20
years old with diabetes, cystic fibrosis or inflammatory bowel
disease. Half participated in MD2Me. The rest received
health-management materials in the mail and served as a control
group.

The intervention included two months of intensive Web-based
and text-delivered education on general disease management.
Tutorials addressed subjects like how to refill prescriptions,
how to monitor symptoms, how to obtain health insurance and how
to talk to doctors and friends about chronic illnesses.

In comparison to controls, the MD2Me participants showed
significant improvements in all targeted outcomes when tested
eight months after the start of the study, the researchers
found. The teens demonstrated that they were significantly more
capable of managing their disease, and reported feeling more
confident in their ability to advocate for themselves.

Moreover, MD2Me recipients initiated an average of two
requests for medical help over eight months, while the controls
initiated none.

"It was a great medical engineering effort," Huang said. "My
dream would be to offer this to all youth in the hospital."

The tool did not have an effect on the severity of young
people's disease or on their quality of life - though those were
not specific goals of the program, the authors note.

Dr. Mark Applebaum told Reuters Health that Huang's program
delivered what teens told him they wanted during focus groups in
San Francisco. They said they preferred to communicate by text
message, and they asked for an online health-management program.

Applebaum, from the University of Chicago, was not involved
in the current study. He described the new program as "a very
good step in the right direction to show that this is a useful
line of work and that we can really make changes in the ability
for teens to take control of their health."

"Their program really did make a positive impact on the
patients' self-efficacy," he said.

"What the study really proved is that the issues children
with chronic illness face are universal - how to call the
doctor, when to call the doctor, how to get medication."

Huang believes that one of her patients, a young man with
inflammatory bowel disease, might have died had he not been
participating in the MD2Me program. The patient had developed
sepsis, a severe, body-wide response to infection. He texted for
help when he first noticed symptoms, got advice and immediately
sought life-saving care, Huang said.

She said she was sad to have to disconnect the MD2Me program
at the end of the study when funding ran out.

"It's too bad the system was shut down," Applebaum said. "I
think it has potential to help teens know more about their
illness, know how to better track and treat their illness and
how to get help when they need it."

As more young people with chronic illnesses live into
adulthood, helping them transition into managing their own care
in the adult system has become an increasingly pressing need,
Applebaum said.

"For patients with chronic illness, once they turn 18 or go
to college, their health status often deteriorates," he said.

"If you leave a voicemail on a teenagers' phone, they're
likely not to check it for a month," he said. "The teens vastly
prefer text messaging."